郭巍++赵春明++崔诗晗

[摘要] 目的 观察急性心肌梗死（AMI）患者的前白蛋白水平，研究其与AMI的病变严重程度的相关性，为早期诊断和检测该病提供依据。 方法 整群选取2011年3月—2013年11月至该科就诊的急性心肌梗死的患者112例为观察组，均行冠脉造影，其结果示单支、2支及3支血管病变的病例数分别为 39、37及36例；观察组分为发生心血管事件42例和未发生者70例；再随机将同时期到该院进行体检的50名患者设为对照组；分别检测并观察两组的前白蛋白差异、观察组内病变不同严重程度的前白蛋白差异及是否发生心血管事件与前白蛋白水平的联系。检测两组的血清前白蛋白水平使用免疫比浊法。 结果 观察组的前白蛋白水平有显著下降，[（0.21±0.07） g/L vs （0.30±0.05） g/L， P<0.05]；对照组与观察组的前白蛋白水平正常率有明显差异（100.0% vs 29.3%， P<0.05）；单支、2支和3支冠脉受累的患者，其前白蛋白水平逐渐下降[（0.25±0.06） g/L vs （0.21±0.06） g/L vs （0.18±0.05） g/L， P<0.05]；根据Spearman相关分析，冠脉病变的严重程度与血清前白蛋白水平呈负相关（r=-0.233， P<0.05）；未发生心血管事件者相比发生心血管事件者，其前白蛋白水平呈较高水平[（0.24±0.07）g/L vs （0.18±0.06） g/L，P<0.05]。 结论 当急性心梗发作后，患者的前白蛋白水平有显著的下降，且其降低的幅度与病变的严重程度相关，可能与患者的预后有关，故可作为指标来对心梗患者的病情变化进行检测和预后进行判断。

[关键词] 急性心肌梗死；前白蛋白；预后

[中图分类号] R7 [文献标识码] A [文章编号] 1674-0742（2015）10（a）-0016-03

Research on the Relationship Between Serum Prealbumin Level and the Severity of Acute Myocardial Infarction

GUO Wei， ZHAO Chun-ming， CUI Shi-han

Department of Nuclear Medicine， Siping Central People's Hospital， Siping， Jilin Province， 136000 China

[Abstract] Objective To investigate the relationship between serum prealbumin level and the severity of acute myocardial infarction（AMI） so as to provide evidence for the early diagnosis and treatment of the disease. Methods 112 AMI patients visited the department from March 2011 to November 2013 were selected as the observation group. The observation group underwent coronary angiography. The result of coronary angiography showed that 39 cases had single-vessel disease， 37 cases had double-vessel disease， 36 cases had triple-vessel disease. 42 cases had cardiovascular events and other 72 cases had not. And 50 cases underwent physical examination during the same period were randomly selected as the control group. Immune turbidity method was used to test the prealbumin level of the two groups and the result of test of the two groups was compared. The prealbumin level was compared between the single-vessel disease patients， double-vessel disease patients and triple-vessel disease patients in the observation group and the relationship between the incidence of cardiovascular events and prealbumin level was investigated. Results Compared with the control group， the serum prealbumin level of the observation group decreased significantly，[（0.21±0.07） g/L vs （0.30±0.05） g/L]， P<0.05. The difference in the normal rate of prealbumin level between the control group and the observation group was statistically significant（100.0% vs 29.3%）， P<0.05. The prealbumin level decreased gradually in single-vessel disease patients， double-vessel disease patients and triple-vessel disease patients[（0.25±0.06） g/L vs （0.21±0.06） g/L vs （0.18±0.05） g/L]， P<0.05. Spearman correlation analysis showed that the serum pre-albumin level was negatively related with the severity of coronary artery 1esions （r=-0.233， P<0.05）. Compared with the patients without cardiovascular events，the patients with cardiovascular events had a significantly lower level in pre-albumin [（0.24±0.07） g/L vs （0.18±0.06） g/L]， P<0.05. Conclusion The level of prealbumin in observation group was significantly lower， and the degree of reduction might relate to the severity and prognosis of the disease. The prealbumin level can be the indicator of AMI condition monitoring and prognosis judgment.

[Key words] Acute myocardial infarction； Prealbumin； Prognosis

急性心肌梗死（AMI）发病的基础大部分为冠状动脉发生病变，而导致血流骤然降低甚而中断，相应的心肌发生持久的、严重的急性缺血[1]。常见原因为斑块破裂、血栓形成引起管腔闭塞，引起严重的心血管事件[2]。故诊断急性心梗需要找到一种敏感而特异的血清标志物，这有助于临床诊治过程。在发生急慢性炎症、严重创伤、感染、心肌梗死时，出现水平明显变化的一类血浆蛋白质，称为急性时相反应蛋白[3]。而血清前白蛋白就是其中的一种负急性时相反应蛋白，严重营养不良及肝功能损害患者也常有较大幅度的降低。临床工作中注意到，前白蛋白作……